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Monday, January 11, 2021

What Work Do You Do?

CPP: If our budgets are based on work that needs done, why do they only reference prescriptions filled?
CP: Because pharmacies fill prescriptions. 
CPP: Then why are we always behind?
CP: We have too many workers filling prescriptions. 
CPP: Said no one. Ever. 
CP: Well that's what Boss Lady said last time I asked. You want to hear that convo?
CPP: Sure. 

BL: Why are you so far behind?
CP: This is actually good. For some reason, the accountants on the 13th floor of "What-The-Phuck-Do-We-Know-About-Tech-Schedules" decided I only needed one tech for today. 
BL: Yet you have 4. 
CP: Nice observation. We like to count by 5's here in the pharmacy so nice work. 
BL: So you're telling me you're over-scheduled and getting further behind. 
CP: Do you like birds?
BL: Yes. 
CP: Do you like Gladiator movies?
BL: Huh?
CP: Birds. When you bird-watch, you have to sit and observe them. You can't just look around and cry "there's one! and there's one, and there's one! I saw some, let's go get chili".
BL: Where are you going with this?
CP: Observe and Report. Watch and Learn. One tech at drive-thru. One tech at the register. One tech at drop-off. One tech doing COVID tests. 
BL: I see that. 
CP: Who is counting my prescriptions?
BL: No one. 
CP: Who is answering my phone?
BL: No one. 
CP: A girl has no name. 
BL: What?
CP: Shooting for a high score in references. Anyway, you asked me earlier why we were behind THEN you proceeded to ask why I wasn't completing my outdates, shining your pumps, and waxing that chin. I thought it was pretty obvious yet you proved me wrong. I was trying to point out the fallacy that is our schedule and your comment was "you're overscheduled yet you are behind". There is a disconnect here and I can no longer respect you. As if that eye makeup weren't enough. 
BL: Well I never. 
CP: And that's the problem. You never did my job. You never took the time to understand what we do. You never hugged me. 

CPP: You okay?
CP: All good. 
CPP: So your long, belabored point was that there is more to our jobs than lick, stick, count, pour?
CP: Basically. Every one of my staff were involved in tasks yet more tasks were demanding their attention. Only one of those techs was actively involved in filling a prescription. Could you imagine if I had allowed the stock schedule to be approved? One tech and I would never be able to accomplish all of this work.
CPP: Seriously. How out of touch does she have to be to not notice or see her surroundings? 
CP: Peaky Blinders. 
CPP: Thuggish Ruggish?
CP: Now let's ask everyone what jobs are you required to do that do NOT involve filling (typing, 3rd party rejects, counting, labeling, bagging, selling the Rx) prescriptions?
-outdates, returns-to-stock, cycle counts, selling non-rx merchandise, answering phones (what types of calls do you answer?), answering random walk-up questions (what questions arise most often?), unlocking the bathroom, et al.

Tuesday, January 5, 2021

You've Certainly "Lost It"

UT: CP, I need your help with this one. 
CP: Certainly. What's the issue?
UT: She needs her refill and the other pharmacy won't fill it. 
CP: I'm supposed to transfer it? 
UT: Yes. 
CP: Can't wait to get the other half of the story from The Other Pharmacist. 

TOP: She lost it. 
CP: Of course. What is she expecting from me? The same answer but in a different voice?
TOP: I offered her a discount price but she "didn't like the one I gave her". 
CP: Phun. 

Lost It Lady Doubting EveryBody But Is Expectant: I need my medication. 
CP: It is too soon. 
LIL DEBBIE: Yes. TOP told me the same thing. But I'm out and I still need it.
CP: I can cash it out for you or you can check for a discount card. 
LIL DEBBIE: No. How many can you give me to hold me until my refill will work?
CP: As many as you wish to pay for today. 
LIL DEBBIE: I don't want to pay for any. My insurance pays for them. 
CP: And they did. But you lost those. Now you wish to replace them and the insurance is saying "not our problem you are irresponsible". 
LIL DEBBIE: But I need them. 
CP: Then you can pay for them. 
LIL DEBBIE: No. My insurance pays for them. 
CP: Only when they are due. The lost/stolen/vacation/dog-ate-my-homework override didn't work either. And I can't "give you some" since I have never filled this, nor any other prescription for you. That's not how business transactions work. 
LIL DEBBIE: How much is it?
CP: That'll be $12.00. 
LIL DEBBIE: I usually pay $5. 
CP: Right. So that's a pretty good deal. 
LIL DEBBIE: No. I only want to pay $5. 
CP: Then you will have to wait until your refill is due and your insurance agrees to pay. 
LIL DEBBIE: Did you call my doctor?
CP: Why?
LIL DEBBIE: To tell him I need them. 
CP: I think he knows you need them. Him telling me "she really needs them" isn't going to make your insurance pay for them, especially since you told me there was no dosage change and that you really lost them. 
LIL DEBBIE: You should call him. 
CP: I will pretend I called him while you pretend you didn't lose them. It's still $12.00 for more today.
LIL DEBBIE: It was only $11.50 with the TOP. 
CP: Shall I transfer it back there? 
LIL DEBBIE: No. I really need it. I'm going to see if I can find it cheaper.

UT: That sounded phun. 
CP: Still trying to figure out how much her time and effort are worth compared to "I really need them" vs. "I need to save $7.00". 
UT: Maybe it's the principle?
CP: Sounds like she needs sent to the principal. 


Use The Force, CP

CP: Have you ever been forced to pay for something you neither wanted nor needed?
CPP: Girl Scout cookies come to mind. 
CP: Okay. That's more of a guilt trip than gun-to-the-head coercion. 
CPP: Agree to disagree. Why the query?
CP: This recent, yet always timely, conversation:

CP: Thanks phor calling CP's Pill Palace. How may I help you?
Lady Out Of Touch Can't Really Afford The Expense: You forced me to pay for this and I don't need it. 
CP: Hmm. Sounds like assault. Did one of my staff have a gun?
CP: Katana Spatula?
CP: Take one of your family hostage?
CP: Menacing look?
CP: Then I am at a loss as to how you were compelled to purchase something against your will. 
LOOT CRATE: She asked for my credit card. 
CP: Which you willingly swiped of your own free will?
CP: Sounds like an open and shut case of a normal business transaction. 
LOOT CRATE: I don't need it. 
CP: How did we receive it?
LOOT CRATE: I don't know. 
CP: <checks profile> Upon further review, it appears as if your prescriber submitted an electronic prescription, hmm, unsolicited by us, to our pharmacy yesterday. Apparently it is a new therapy. Did you contact the office recently?
CP: Aaaand. . . ?
LOOT CRATE: She said she would send it to the doctor for review. 
CP: Aha. You initiated a call to your provider who, upon further review herself, decided therapy was warranted and, taking the next logical step, sent us the prescription which you then ran down to the pharmacy to retrieve, right? 
LOOT CRATE: Yes. But I don't need it.
CP: Did you mention this to your provider? 
CP: When you were at the counter, did you ask any questions about the medication; what it was? what it was for? side effects? anything? *
CP: Hmm. So you just picked up a random medication you were not expecting, paid for it, took it home, THEN decided you didn't need it?
CP: Ok. What do you wish? 
LOOT CRATE: For my money back. 
CP: First, I cannot do that. Second, your copay was $1.89. That was a pretty cheap lesson. Next time, ask us what you are picking up. It's a good habit to employ at other places as well. (Boy, this bag feels light/heavy. What's in here? Did I get all of my stuff?) 
LOOT CRATE: Well I don't need this. 
CP: Then make sure you call your provider and let her know you have not and will not start the therapy she prescribed for you. We can't allow you to be more non-compliant.

*Yes. A pharmacist walking up to the counter to counsel may have helped. It may not. Maybe she drove off from the drive thru instead of waiting, maybe the RPh was giving a shot and she didn't want to wait, maybe she was offered counsel and she refused, maybe this, maybe that. We ALL know how our days go and not every one of our 600 patients/day receive a proper counsel. Maybe. Maybe not. Let it go. That's not the point of the story.

Monday, January 4, 2021

A Phunny Thing Happened On The Way To Vaccination

CP: It's time for another "Good Idea/Bad Idea".
MICE ELF: Ooh. I love these. What's today's topic?
CP: COVID Vaccinations. 
ME: Lame. 
CP: Hear me out on this one. 
MICE ELF: The floor is yours. 
CP: GOOD IDEA: Utilising pharmacists in the campaign to inoculate the public. 
ME: I agree. It's about time we were seen as the healthcare professionals we are and valued for the service we can provide. 
CP: Except this comes on the heels of flu shot season so everyone has this opinion that's it's just a walk-up-and-ask-and-wait-and-be-out-in-five-minutes sort of campaign. It's not as if we don't have other work to do.
MICE ELF: I'm all in favour of pharmacists-as-immunizers. Where is the issue? 
CP: BAD IDEA: Giving the contracts to the two largest pharmacy chains in the country to control distribution. It has been nothing short of a train wreck according to most media and anecdotal reports. 
ME: Why is that bad? They collectively own nearly 20,000 stores across the country. Surely they have the presence and capacity to distribute and administer vaccines on the necessary scale? Surely? Right? 
CP: When was the last time you spoke with a retail pharmacist at one of these locations? 
MICE ELF: Only what I read on Facebook.
CP: Ask any retail pharmacist if they believe their employer, especially the chains, have enough staff to cover the normal day-to-day operations of their stores. The NUMBER ONE COMPLAINT against these companies is that they are woefully, dangerously understaffed. Yet these are the hands into which we placed this critical task? If ever there were a more government move than that, I can't think of one. 
ME: You're saying they focused on big business? 
MICE ELF: To a point, it played a part, certainly. 
CP: My questions are these:
-Why are we not following the model of previous, successful campaigns (Polio)?
-Why, with months to plan this rollout, did the chains not train their techs and hire more staff sooner?
-Why, with months to plan this rollout, did counties not assemble teams of all personnel who could administer vaccines so they could administer them in a more logical, centralised manner?
-Why are we not using the National Guard to help coordinate and facilitate administration (it's worked before.)? <and no, fear is not a good excuse in case someone wishes to use that.>
-Why are we not using schools or stadiums for large groups of people? (Imagine social distancing at an indoor NFL stadium or NBA arena with The Guard there to organize crowds by zip code on certain dates and times. Obviously, once we get past the LTC/1A stage.)
-Why were clinics not scheduled by county departments of Health and submitted to "The Big Deuce (cvs and wag's)" in a better manner? (Again, they had months to strategise/organise this.)
ME: So you're saying they done messed up?
CP: Yes. While other countries are doing a somewhat better job at jabs than we are, we should be doing far better. Handing the reins to "The Big Deuce" was a mistake. I have friends who are nurses and pharmacists who are trying to apply, today, with these companies to join the jab list but are having trouble getting responses. Former techs who now work there report they are to undergo training for administration "soon". Reports from phriends who are working these clinics have not been positive either; "disorganized", "chaotic", "ridiculous", and "phuckery at its phinest" were a phew of the words/phrases I heard recently. 
ME: It's still early. 
CP: And it's a train wreck. 
MICE ELF: Well you can't complain about the government rewarding big business and calling it a mistake then suggesting they roll out The Guard. 
CP: There's a difference between "here's millions of dollars to be in charge of this" and "hey, here's some help setting up tents and organization since, you know, that's one of the things at which we excel here at home". 
ME: The US had administered 4.2 million jabs so far, as of 1/2/21. That is woefully inadequate considering the number of doses available. 
MICE ELF: And the number going to waste. 
CP: Yes. I know. There was uncertainty as to whom would receive doses and how many would be allocated. But. . . there needed to be plans in place and relying on these retail giants was a mistake. Period. 
I hope it improves.
I'm not optimistic today. 
I managed to receive a jab for myself. 
It wasn't easy to obtain. 
We can't give shots to people who don't want them, but we need to be able to administer them to those who do. 
And The Big Deuce dropped the load here.

Tuesday, December 22, 2020

What A Waste

ME: CP has that look. 
MICE ELF: Someone pissed in the morning Cheerios. 
ME: Something happened that defies logic; that CP just can't compute and I think shortwired the brain. 
MICE ELF: Well let's ask. 
ME: Nicely. 
ME + MICE ELF: CP? Are you okay? It's okay. You can tell us. 
CP: There is a reason other countries have looked at us over the last year, shaken their heads, and felt sorry for us. I could handle if they laughed at us, but they're sorry for us. 
ME + MICE ELF: Elaborate. 
CP: You saw how our Congressional representatives began receiving their COVID vaccines?
ME + MICE ELF: Right. To encourage their constituents to receive the vaccine. 
CP: Sure. But members who are not included in the first wave of qualification also received theirs. Feels as if they should set an example as well that they are healthy and should await their turns. 
ME: Good point. But there seems to be something else.
MICE ELF: Yes. Like the main point of this post. 
CP: I'm not administering the COVID vaccine. I don't have it. However, I have phriends who do have it and are working clinics for their respective pharmacies and here's a little story that I got to tell. . . 
Pfizer's vaccine is good out of its frozen state, in a refrigerator for up to 5 days. 
The clinics require there to be extra vaccine available. Just in case. 
IF the clinic does not use all of the vaccine, the extra can be returned to the fridge to live out the remainder of its 5 days. 
HOWEVER, if another clinic is not scheduled/held during that time, the vaccine is destroyed. 
ME + MICE ELF: Can the pharmacy staff administer it to their employees? Or their employees' families? Or first responders? Or anyone else in the 1A group?
CP: NO. They have been told it is against the law. 
ME: Aren't pharmacists and pharmacy staff and pharmacy store employees considered healthcare workers?
CP: No. 
MICE ELF: Wait. Hold up. You're telling me that the pharmacists administering the vaccines, or working in their pharmacies, waiting on potentially sick people all day, consulting with them in the aisles about how to treat their symptoms do not count as first-line healthcare workers; that they can't receive a vaccine that is in desperate need that is otherwise going to go to waste; and the government employees who don't qualify have already received their vaccine?
CP: Well, those administering the vaccines can get theirs at the end of the clinic, but only those staff who work the clinics can receive the vaccine. Not the rest of their staff still working the bench in the stores. 
ME: And someone in the government signed off on this? 
CP: If there was anything more American Governmental than wasting this precious commodity, I can't think of one. 
MICE ELF: I wonder if this is across the country? Across all states? *
CP: It shouldn't matter. Everyone should be pissed. There are reports of nurses that don't want it. I'm sure there is pharmacy staff who don't. But I do. Many of my pharmacy friends and staff do. If I can get it so it doesn't go to waste, why can't I? Why should I, as a healthcare worker not be allowed, be told it's against the law, to receive it? Why are these vaccines going to go to waste?

*Having checked as of the posting, it is not against any FEDERAL law. It may be state specific or local health department-specific. Check your local/state agencies and inquire about this. Do NOT let these shots go to waste!

Wednesday, December 9, 2020

Problems With Vitamins

From a professional view, I loathe dosing on vitamins/supplements. (This is not about my opinions on vitamins/supplements themselves, for that is another beast altogether.) The current, normal dosing is based on advertising and not ease-of-use for the patient. 
In much the same way as food labels are based on servings, so are supplements. (When is the last time you shared a can of Chunky Soup with someone? You should because a single can is two servings.)

Melatonin 5mg Gummies. It says so right on the front of the bottle. It says it on the sticker at your pharmacy. "5MG". Clear as can be. No way to misinterpret "5MG". 
Except. . . 
When you, as a do-your-due-diligence practitioner, read the back of the label and check "serving size", you notice the serving is actually two (2) gummies. Hmm. That would make each gummy only 2.5mg. Does that make each dose 2.5? 
When I, as a pharmacist, use these to fill a prescription, I will write "Chew 1 gummy once a day" to convey the simple fact that your dose is 2.5mg. 
When you, the patient, grab a bottle off the shelf, and see "5mg", will you only give your child one gummy? This would mean you are underdosing her at 2.5mg, right? Right.
See why I don't like this? 
Can you see what other issues may arise? 
Maybe a patient doubling the dose and actually taking the 5mg dose, (all the while believing they were taking 10mg) then buying a 10mg, thereby unintentionally doubling that dose?
Sound farfetched? Sound cynical? Sound like something I have complained about before? 
It sounds like something that actually happened recently. A mom bought the same bottle OTC that I used to fill her daughters' prescriptions. Had she not come to me for counsel, she would have doubled their dose. 

Fine. It's melatonin. No big deal. 
Okay. What about the Glucosamine-Chondroitin products? They clearly state if they are double- or triple-strength.
Sure. Just like buying paper products, the math here is frustratingly complicated. 
First, you have to know what "Single-Strength" is. And is that in 1 tablet? 2 tablets? 4? 
Then, is the "Double-strength" a single tablet? Or 2? Or 3? 
Don't get me started on the "Triple Strength" where a single dose is 2 tablets. 

It's all marketing. Unless people can do the math or are wise enough to seek counsel with the White Coats in the back, there can be issues with taking too much or too little of many OTC products. 

(Anticipatory Devil's Advocate rebuttal: geesh CP. they're only OTC supplements. who cares? it's not like they can OD or anything. they don't really do anything anyway, right? it's not like they're real medications.)
Right. Except lots of children take melatonin (and other OTC products) and lots of people believe that "if one is good, two is better" and many patients never report their OTC products while giving medication histories. 

Also, it's not just about Melatonin and Osteo-Bi-Flex. There are many OTC products that can be easily under- or overdosed due to unclear labels. 
Shouldn't there be a call for a change to happen? 
If the label says "10mg" then I expect the bottle to contain 10mg doses, not 2.5mg or 5mg "partial servings". 
I wonder how often mistakes are made based on OTC labeling because it's designed on marketing instead of safety?

Tuesday, December 8, 2020

Dear Board Of Pharmacy

I have a question for my BOP.
Perhaps you too will share this question.
CP: Dear BOP, do you have to approve pharmacist license applications?
BOP: Yes.
CP: Do you have to approve companies that do business with the State BOP?
BOP: Yes.
CP: Do you have to certify e-script providers and other vendors that do business with the State BOP?
BOP: Yes.
CP: Okay. Do you suspend licenses of pharmacists in the State?
BOP: Yes.
CP: If a pharmacist was asked to complete something as part of her registration, and told you "NO", could you revoke their license?
BOP: Yes.
CP: If a vendor said "NO", could you do the same thing?
BOP: Nope.
CP: Why not? You know that you have approved over 200 e-rx systems in the State. You know that one of the providers has refused to fix a known issue with their software.

(Here's the background. If an e-rx is sent by a prescriber, it passes from the office system to another processor who passes it on to Emdeon. They in turn pass it to a switch who is responsible for passing it to the pharmacy. IF, at any point it does not make it to Emdeon, whether due to a system outage or a "glitch", the e-rx is routed directly to my fax machine. This comes complete with no signature by the prescriber. My state has mandated that these Rx's are, in fact, not legal. We are required by the State BOP to call on each of these Rx's. They even have a disclaimer at the top that reads "Warning. This is not a valid Rx until called to verify by the pharmacist." What's even better is, we then have to transcribe it as a verbal order instead of an e-rx, thereby circumventing the intent of the e-rx in the first place.)
Still with me? Good. Now, despite repeated conversations between the company and the BOP, the company has refused to take the action that the other two big e-rx players have and that is to change their software to allow signatures to be printed on the faxes. They also contain a disclaimer that essentially reads "this started as an e-rx but due to a system error or glitch, got routed to your fax instead. It is totally valid so feel free to dispense it. Approved per State BOP", or something to the effect.
BOP: What's your question again?
CP: Why can't you just revoke their approval? Like you would a license?
BOP: Because.
CP: Oh. Okay. What do you suggest?
BOP: Call the offices that use this software and speak to their office managers. Explain the situation and why you have to call all the time, even though they get frustrated with you, and have them complain to their software vendor. Maybe, once enough offices complain about all the phone calls, the company will relent.
CP: Or you could just give them 90 days to be in compliance or threaten them with the loss of their license.
BOP: The Board of Medicine wouldn't go for that. Too many doctors would complain.
CP: Gotcha. So you approved a system that basically tells all the pharmacists to piss off, makes more work for us, then you tell us it is OUR responsibility to call on something you could fix, because you, the Board of Phrickin Pharmacy, are afraid of what a group of prescribers will do?
BOP: Yes. Pharmacists have no backbone and won't stand up to us. We only approve the systems.
CP: I got nothing. I need to relocate.

Wednesday, December 2, 2020

O Seltamivir (O Tannenbaum)

Pronounced: O SELT um a VEER

O Seltamivir, O Seltamivir
My how you help my symptoms
O Seltamivir, O Seltamivir
My how you help my symptoms
Your price is high but that's okay
You really don't work anyway
O Seltamivir, O Selatamivir
Nah you don't help my symptoms

O Seltamivir, O Seltamivir
Why are you never in stock
O Seltamivir, O Seltamivir
Why are you never in stock
The same time each and every year
The flu like clock-work reappears
O Seltamivir, O Seltamivir
Why are you never in stock

O Seltamivir, O Seltamivir
It's time to be backordered
O Seltamivir, O Seltamivir
It's time to be backordered
Xofluza's new, competes with you
Though it's not cheap, one dose will do
O Seltamivir, O Seltamivir
It's time to be backordered

O Seltamivir, O Seltamivir
You let us know, flu is near
O Seltamivir, O Seltamivir
You let us know, flu is near
So many scripts, we do receive
Yet out of stock, we can't believe
O Seltamivir, O Seltamivir
You're such a disappointment.